The tours take place every other Friday, and are open to anyone, but it is suggested that they are particularly useful for those who need to lose weight, who are at high risk or with a family history of heart disease, or who have diabetes.

Sources: Lewisham Life, November 2011 and Lewisham NHS Trust website.

The lifting of the restrictions on imports in a country with one of the highest rates of obesity in the world (32 per cent of men and 63 per cent  of women are estimated to be obese) was certainly not welcomed by health campaigners. As Samoa’s director general of health, Palanitina Tupuimatagi Toelupe, put it: ‘These are the contradictions we have to face—where health is compromised for the sake of trade and development.’ Another Pacific Island, Tonga, also had to water down proposals to restrict imports on the back of its WTO membership, which confers increased trade and lowered import costs.

The balance between health and trade is a fine one: but is it not time to prioritise health?

Sources: Business Week, 22 November 2011; Taking up the Challenge of NCDs in the Commonwealth: 17 Good-practice Case Studies (C3 and Commonwealth Secretariat), click here >>

Sources: Stone Hearth News, 1 December 2011; Gender and Race Wage Gaps Attributable to Obesity (click here >>)

Recent articles have been a reminder of the social gradient in health and wellness, reinforcing that the poor are more likely to be overweight or obese, but the question remains as to whether this is because of a diet of fast-food restaurant dining.  The December issue of Population Health Management will debunk this assumption, with a recent UC Davis Centre for Healthcare Policy and Research study demonstrating that dining at fast -food restaurants is more popular among the middle class than low-income diners.

This nationwide US study by two health economists uses data from the 1994-1996 Continuing Survey of Food Intakes, which assesses food consumption among 5,000 individuals, and suggests that obesity linked to food choices cannot be attributed solely to fast-food restaurant dining. Their research shows that up to an annual household income of $60,000, fast-food restaurant dining increases, peaks and then tapers off as incomes rise and diners choose other restaurant types.

Professor Leigh, one of the study authors, speaks to the crucial function of pricing for low-income families and notes that, in the US, the cost of less healthy dining options have dropped significantly compared with healthier options over the last 30 years.  Now that the picture of restaurant selection according to income is more clear, the authors suggest that the pricing metric, rather than restaurant type, should be explored as an approach to encouraging healthier food choices.

Others, reporting on these study results, note that the environments in which people live do indeed matter. Family diets are, of course, composed of multiple food selections and choices, of which dining out is but one category. The question around what sort of food people have available to them locally is still a crucial one.  Nor, as health policy advisor Micah Weinberg  commented, does the study distinguish between rural and urban dining practices and trends.

Sources: UC Davis Health System bulletin, 27 October 2011; Time Healthland, 7 November 2011;  The Sacramento Bee, 28 October 2011; Population Health Management, Kim and Leigh, (article forthcoming) December 2011.

The poll used a Well-Being Index of self-reported height and weight to calculate BMI, and took note of chronic conditions including major NCDs, high blood pressure or cholesterol or recurring pain in neck, back or legs in the past 12 months. It estimated that the lost productivity among those who are overweight or with a condition is more than $153 billion. Compared with the healthy, normal weight workers – who make up just 14 per cent of full-time employees – those with health and weight issues miss an estimated 450 million extra days of work a year.

Unhealthy days were calculated using answers to a question about how many days in the past month respondents found that poor health kept them from doing usual activities, with the poll indicating that a day of work is missed for roughly every three unhealthy days.

Healthy, normal weight full-time workers averaged 0.34 unhealthy days each month, or about four days per year, with a tiny rise for workers who were overweight with no chronic conditions – but overweight workers with three or more chronic health conditions (about 18 per cent of the workforce) reported an average of about 42 unhealthy days per year.

And it is not just in the United States: the workforce is not much healthier in the United Kingdom – just 20 per cent of employees are neither overweight nor have a chronic condition.

Source: Reuters, 17 October 2011.

The importance of the ‘early origins of health’ has also been stressed in the UK’s National Institute of Clinical Excellence updated guidance on maternal and child nutrition, particularly aimed at supporting nutrition of pregnant mothers and breastfeeding women, to aid the health of infants in low-income households.  Current recommendations will be updated to align them with present World Health Organization advice. The Scientific Advisory Committee on Nutrition (SACN) has also been considering issues relevant to maternal and child health and will issue multiple reports by 2014;  at this latter point, an expert group will take on SCAN reports and issue revised clinical guidance, although the expert panel convened suggests that there is insufficient evidence to recommend policy change at this time.

NICE recommendations refer to the recently updated guidance issued by the Department of Health on infant feeding. DH guidance provides detailed recommendations around baby feeding via commercial products but emphasises: ‘Breast milk is the best form of nutrition for infants, and exclusive breastfeeding is recommended for the first six months (26 weeks) of an infant’s life.  Thereafter, breastfeeding should continue as long as the mother and baby wish, while gradually introducing the baby to a more varied diet.’

Sources: NICE review of guidance on ‘Improving the nutrition of pregnant and breastfeeding mothers and children in low-income households’ here >> and a ‘Review decision’ on ‘Maternal and child nutrition’ here >> (July 2011), and The Guardian, 3 August 2011.

One in six of the people using the restaurants were found to have used the nutrition information, and most who used it reduced their calorie intake as a result. In 2007, before the introduction of the scheme, 7,000 people were surveyed, and a further 8,500 in 2009, after its introduction. Among the 15 per cent of customers who used the labelling, 106 fewer calories were purchased.

However, the survey also found a much bigger influence on consumers by actions of the restaurants – for example, through changing menus to include healthier options, or altered portion size.

Dr Susan Jebb, from the UK’s Medical Research Council, commented that the situation could be different in the UK, were the labelling to be introduced there: ‘[We are much more used to looking at front-of-pack labelling in supermarkets [in the UK] so I would expect more people to use calorie information than the one in six in New York. But this study also illustrates the importance of how the restaurant or food chain acts. It is going to require a combination of factors to make a big difference.”

Source: BBC News online, 27 July 2011.

The economic impact of NCDs – and the economic benefit of preventing them – is potentially vast. Spending on health has tripled from 2000 to 2009, and is estimated that this could grow by another 50 per cent in five years. Despite this, little is spent on specialists in NCD prevention and control, which could pay dividends. Were CVD mortality to be reduced by 1 per cent per year between 2010 and 2040, this could generate an economic value of PPP US$10.7 trillion – and at the level of individuals, a change in adult health status can result in a 16 per cent increase in hours worked and a 20 per cent increase in individual income. The least well off are worst affected by NCDs: in low income groups, over 30 per cent of people with NCDs were not hospitalised despite medical advice to do so, with over 80 per cent of them citing economic hardship as the reason for not doing so.

The report makes some practical suggestions for priority interventions, such as raising tobacco taxes, which are currently relatively low (36 per cent of the cost of tobacco, compared to nearly 60 per cent in Brazil), reducing salt intake, screening and providing basic treatments such as statins. Combining the suggested interventions at a cost of around $220 per person per year, the report estimates that 600–800 million DALYs could be averted each year over 10 years, reducing the estimated NCD burden by between 45 and 60 per cent.

It also suggests building health outcomes into the next Five-year Plan (2011–2015), as this could help to raise the profile of health across all sectors – education, employment, transport and urban/rural development.

Source: World Bank, Towards a Healthy and Harmonious Life in China: Stemming the Rising Tide of Non-communicable Diseases.

As well as regional retailers, SUPERVALU, Walgreens and Walmart have all joined the scheme, which is expected to see 1,500 more stores opening around the country, reaching 9.5 million people out of the estimated 23.5 million who live in these low-income areas.

Partnership for a Healthier America secured the commitments from the retailers, and will work with and monitor the efforts. The national stores’ pledges are that SUPERVALU has committed to opening new stores (250 over the next five years in the case of the former), Walmart has pledged to open or expand 300 stores by 2016, and Walgreens (the largest chain of drugstores in the country) committed to expanding to include whole fruits and vegetables, and other healthy options, in at least 1,000 stores.

Mrs Obama stressed that the move is essential: ‘We can give people all the information and advice in the world about healthy eating and exercise, but if parents can’t buy the food they need to prepare those meals because their only options for groceries are the gas station or the local minimart, then all that is just talk.’

While some have questioned the motives behind this – whether it is merely an excuse for larger retailers to expand their consumer base – the fact remains that extending access to healthy products is essential if the health of many lower socioeconomic communities in the United States is to be improved, and removing ‘food deserts’ forms an important part of the fight against, in particular, childhood obesity.

A factsheet is available online here >>

Source: White House press release, 20 July 2011.

C3 tweeted live from the event – you can see our Twitter stream at www.twitter.com/c3health.

After introductions from the president of the General Assembly and the deputy secretary-general, Ala Alwan of the WHO stated that civil society’s views are essential for informing the High-Level Meeting in September, which will take action on the challenge of NCDs: of the 32 million people who die of NCDs this year, 9 million will be under 60, and 90 per cent of that 9 million will be from developing countries.

The first session, ‘The scale of the challenge’, heard from speakers including Dr Betsy Nabel, Dr Tom Frieden and Professor David Bloom. Professor Bloom’s research into the costs of NCDs are already producing some striking figures – the foregone output due to NCDs between 2005 and 2030 is estimated at a staggering $35 trillion. As he put it, it would be irresponsible to ignore NCDs if you are interested in poverty reduction – and the focus on the link between NCDs and development was a constant theme during the day.

The second session, on the national and local challenges of NCDs, included discussion on the impact of NCDs on the very poorest, and the need for ‘Prevention, prevention, prevention’. And there is no time to waste: as Ruth Colagiuri put it, ‘Start somewhere, start anywhere, start as small as you like – but start now!’ The session heard from around 15 contributors from the floor – there was considerable enthusiam from delegates to have their voices heard, and those who could not be accommodated were encouraged to email their opinions in within the next day or two so that they could be included in the summary document arising from the meeting and the online consultation that preceded it.

The final roundtable was on how to enhance global cooperation (although no mention was made of the uses for social media). Rachel Nugent spoke of the tiny proportion of donor funding (less than 3 per cent) that goes on NCDs – orders of magnitude difference from the trillions of dollars that delegates had been told is being lost to the diseases.

Other themes that recurred throughout during the day were:

• the need to engage with patients, who best know how to deal with the challenges, and make them global champions in the fight against NCDs;
• working across silos, in collaboration not competition with other disease organisations – strengthening health systems benefits all;
• tackling health and health education of children – our generation may have ‘missed the  boat’, but there is much that can be done to protect the health of the young;
• the need for significant improvements in implementing the Framework Convention on Tobacco Control (as one delegate put it, in tight financial times, why are governments not further utilising the revenue potential of tobacco taxes?); and
• multi-sectoral partnership – government cannot do this alone, which is why it is essential for civil society, business and others to come together to face the challenge.

The day closed with a speech from Sir George Alleyne, who called on us to agitate, educate, integrate and communicate on NCDs.

An interesting day – one that was good for reconnecting with old partners and meeting new ones, and one that C3 hopes will feed into the planning for a successful and effective UN High-Level Meeting in September.